A systems science perspective on the capacity for change in public hospitals

J. Braithwaite, J. Westbrook, E. Coiera, W. B. Runciman, R. Day, K. Hillman, J. Herkes

Research output: Contribution to journalComment/debate

5 Citations (Scopus)

Abstract

Many types of organisation are difficult to change, mainly due to structural, cultural and contextual barriers. Change in public hospitals is arguably even more problematic than in other types of hospitals, due to features such as structural dysfunctionalities and bureaucracy stemming from being publicly-run institutions. The main goals of this commentary are to bring into focus and highlight the "3 + 3 Decision Framework" proposed by Edwards and Saltman. This aims to help guide policymakers and managers implementing productive change in public hospitals. However, while change from the top is popular, there are powerful front-line clinicians, especially doctors, who can act to counterbalance top-down efforts. Front-line clinicians have cultural characteristics and power that allows them to influence or reject managerial decisions. Clinicians in various lower-level roles can also influence other clinicians to resist or ignore management requirements. The context is further complicated by multi-stakeholder agendas, differing goals, and accumulated inertia. The special status of clinicians, along with other system features of public hospitals, should be factored into efforts to realise major system improvements and progressive change.

Original languageEnglish
Article number16
JournalIsrael Journal Of Health Policy Research
Volume6
Issue number1
DOIs
Publication statusPublished - 24 Mar 2017
Externally publishedYes

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Public Hospitals
Cultural Characteristics
Organizations

Cite this

Braithwaite, J., Westbrook, J., Coiera, E., Runciman, W. B., Day, R., Hillman, K., & Herkes, J. (2017). A systems science perspective on the capacity for change in public hospitals. Israel Journal Of Health Policy Research, 6(1), [16]. https://doi.org/10.1186/s13584-017-0143-6
Braithwaite, J. ; Westbrook, J. ; Coiera, E. ; Runciman, W. B. ; Day, R. ; Hillman, K. ; Herkes, J. / A systems science perspective on the capacity for change in public hospitals. In: Israel Journal Of Health Policy Research. 2017 ; Vol. 6, No. 1.
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Braithwaite, J, Westbrook, J, Coiera, E, Runciman, WB, Day, R, Hillman, K & Herkes, J 2017, 'A systems science perspective on the capacity for change in public hospitals' Israel Journal Of Health Policy Research, vol. 6, no. 1, 16. https://doi.org/10.1186/s13584-017-0143-6

A systems science perspective on the capacity for change in public hospitals. / Braithwaite, J.; Westbrook, J.; Coiera, E.; Runciman, W. B.; Day, R.; Hillman, K.; Herkes, J.

In: Israel Journal Of Health Policy Research, Vol. 6, No. 1, 16, 24.03.2017.

Research output: Contribution to journalComment/debate

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AU - Coiera, E.

AU - Runciman, W. B.

AU - Day, R.

AU - Hillman, K.

AU - Herkes, J.

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KW - Complexity science

KW - Health systems

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KW - Public health

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